| Values |
| Female |
| Male |
| prefer not to disclose |
| X |
| Field Name | Data Type | Value |
| Program | Dropdown | Orthotist and Prosthetist |
| Professions | Dropdown | Prosthetist |
| Prosthetist License | Checkbox | True |
| Text |
| Indicates a required field |
| Please review your demographic information below: |
| Note: If any of the information above is incorrect, please submit a 'Change of Personal Information' submission within the applicant portal. |
| Have you ever been known under any other names? Will this application contain documents with your different name? |
| Field Name | Data Type |
| Street | Text |
| City | Text |
| Country | Dropdown |
| State | Dropdown |
| Zip Code | Text |
| County | Text |
| Field Name | Data Type |
| Phone Number | Phone |
| Cell Number | Phone |
| Email Address |
| Field Name |
| Middle Name |
| First Name |
| Last Name |
| Date of Birth (mm/dd/yyyy) |
| Social Security Number |
| Gender |
| Field Name | Data Type | Value |
| Country | Dropdown | United States |
| Field Name | Data Type |
| State | Dropdown |
| Field Name |
| County |
| Field Name | Data Type | Value |
| Zip Code | Text | 12346789 |
| Error Message |
| Invalid ZipCode Format |
| Field Name | Data Type | Value |
| Country | Dropdown | Canada |
| Field Name | Data Type |
| State | Dropdown |
| Field Name | Data Type | Value |
| Zip Code Canada | Text | 12345 |
| Error Message |
| Invalid ZipCode Format |
| Field Name | Data Type | Value |
| Country | Dropdown | Afghanistan |
| Field Name | Data Type |
| State | Text |
| Field Name |
| County |
| Field Name |
| Alternate Names: |
| Field Name | Data Type | Value |
| Alternate Names: | Text | Auto |
| Field Name | Data Type |
| Street | Text |
| City | Text |
| Country | Dropdown |
| State | Dropdown |
| Zip Code | Text |
| County | Text |
| Field Name | Data Type |
| Street | Text |
| City | Text |
| Country | Dropdown |
| State | Dropdown |
| Zip Code | Text |
| County | Text |
| Field Name | Data Type | Value |
| Country | Dropdown | United States |
| Field Name | Data Type |
| State | Dropdown |
| Field Name | Data Type | Value |
| Zip Code | Text | 123456789 |
| Error Message |
| Invalid ZipCode Format |
| Field Name | Data Type | Value |
| Zip Code | Text | 12345 |
| Field Name | Data Type | Value |
| Country | Dropdown | Canada |
| Field Name | Data Type |
| State | Dropdown |
| Field Name | Data Type | Value |
| Zip Code Canada | Text | 12345 |
| Error Message |
| Invalid ZipCode Format |
| Field Name | Data Type | Value |
| Zip Code Canada | Text | 123456789 |
| Field Name | Data Type | Value |
| Country | Dropdown | Afghanistan |
| Field Name | Data Type |
| State | Text |
| Error Message |
| Error: 1. Do you have a medical condition which in any way impairs or limits your ability to practice your profession with reasonable skill and safety? is required. |
| Error: 2. Do you currently use chemical substance(s) in any way which impair or limit your ability to practice your profession with reasonable skill and safety? is required. |
| Error: 3. Have you ever been diagnosed with, or treated for, pedophilia, exhibitionism, voyeurism or frotteurism? is required. |
| Error: 4. Are you currently engaged in the illegal use of controlled substances? is required. |
| Error: 5. Have you ever been convicted, entered a plea of guilty, no contest, or a similar plea, or had prosecution or a sentence deferred or suspended as an adult or juvenile in any state or jurisdiction? is required. |
| Error: 6a. Possessed, used, prescribed for use, or distributed Controlled Substances or Legend drugs in any way other than for legitimate or therapeutic purposes? is required. |
| Error: 6b. Diverted controlled substances or legend drugs? is required. |
| Error: 6c. Violated any drug law? is required. |
| Error: 6d. Prescribed controlled substances for yourself? is required. |
| Error: 7. Have you ever been found in any proceeding to have violated any state or federal law or rule regulating the practice of a healthcare profession? is required. |
| Error: 8. Have you ever had any license, certificate, registration or other privilege to practice a healthcare profession denied, revoked, suspended, or restricted by a state, federal, or foreign authority? is required. |
| Error: 9. Have you ever surrendered a credential like those listed in number 8, in connection with or to avoid action by a state, federal, or foreign authority? is required. |
| Error: 10. Have you ever been named in any civil suit or suffered any civil judgement for incompetence, negligence, or malpractice in connection with the practice of the healthcare profession? is required. |
| Error: 11. Have you ever been disqualified from working with vulnerable persons by the Department of Social and Health Services (DSHS)? is required. |
| Bold Text |
| Note: If you answer 'yes' to any of the remaining questions, provide an explanation and certified copies of all judgements, decisions, orders agreements and surrenders. The department does criminal checks on all applicants. |
| Field Name | Data Type | Value |
| 1a. Please explain medical condition. | Textarea | Test Medical Condition |
| 1b. Please explain how your treatment has reduced or eliminated the limitations caused by your medical condition. | Textarea | Test Limitations |
| 1c. Please explain how your field of practice, the setting or manner of practice has reduced or eliminated the limitations caused by your medical condition. | Textarea | Test limitations caused by your medical condition |
| Field Name | Data Type | Value |
| 2a. Chemical Substance Explanation | Textarea | Test Chemical Substance |
| Field Name | Data Type | Value |
| 3a. Diagnosis Explanation | Textarea | Test Diagnosis Explanation |
| Field Name | Data Type | Value |
| 4a. Controlled Substances Explanation | Textarea | Test illegal issue |
| Field Name | Data Type | Value |
| 5a. Conviction Explanation | Textarea | Test Conviction Explanation |
| Field Name | Data Type | Value |
| 6a. Controlled Substance Legal Explanation | Textarea | Test Controlled Substances Explanation |
| Field Name | Data Type | Value |
| 6b. Criminal Proceedings Explanation | Textarea | Test Criminal Proceedings |
| Field Name | Data Type | Value |
| 6c. Drug Law Violations Explanation | Textarea | Test Drug Law |
| Field Name | Data Type | Value |
| 6d. Self Prescribed Controlled Substance Explanation | Textarea | Test Self Prescribed |
| Field Name | Data Type | Value |
| 7a. Violation of State or Federal Law Explanation | Textarea | Test Violation of state |
| Field Name | Data Type | Value |
| 8a. License, Certificate, Registration Issue Explanation | Textarea | Test License Certificate |
| Field Name | Data Type | Value |
| 9a. Surrender Explanation | Textarea | Test surreender explanation |
| Field Name | Data Type | Value |
| 10a. Civil Judgement Explanation | Textarea | Test Civil Judgement |
| Field Name | Data Type | Value |
| 11a. Vulnerable Persons Disqualification Explanation | Textarea | Test Vulnerable persons |
| Text |
| A National Provider Identifier or NPI is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). |
| Field Name | Data Type | Value |
| 1. Enter your National Provider Identifier (NPI) Number if available. | Text | 123456 |
| Error Message |
| NPI is 10 digits. |
| Field Name | Data Type | Value |
| 1. Enter your National Provider Identifier (NPI) Number if available. | Text | 1234567890 |
| Error Message |
| NPI is 10 digits. |
| Text |
| Indicates a required field |
| Link |
| Add |
| Error Message |
| Please add at least one other license, certificate or registration |
| Button Name |
| Add |
| Text |
| Indicates a required field |
| List all additional states and jurisdictions where credentials are or were held. |
| Error Message |
| Error: Country is required. |
| Field Name | Data Type | Value |
| Country | Dropdown | United States |
| Error Message |
| Error: State or Province is required. |
| Error: Profession is required. |
| Error: Credential Type is required. |
| Error: Credential Number is required. |
| Error: Issue Date is required. |
| Error: Expiration Date is required. |
| Error: Is this credential currently in an active status? is required. |
| Error: How did you receive this credential? is required. |
| Field Name | Data Type | Value |
| How did you receive this credential? | Dropdown | Grandparented |
| State or Province | Dropdown | Alabama |
| Profession | Text | Test Doctor |
| Credential Type | Dropdown | Temporary |
| Credential Number | Text | 12345678 |
| Issue Date | Date | Today - 100 |
| Expiration Date | Date | Today - 0 |
| Field Name | Data Type | Value |
| Credential Number | Text | 23456789 |
| Field Name | Value |
| Credential Number | 23456789 |
| Field Name | Data Type | Value |
| Country | Dropdown | United States |
| How did you receive this credential? | Dropdown | Grandparented |
| State or Province | Dropdown | Alabama |
| Profession | Text | Test Doctor |
| Credential Type | Dropdown | Temporary |
| Credential Number | Text | 12345678 |
| Issue Date | Date | Today - 100 |
| Expiration Date | Date | Today - 0 |
| Field Name | Data Type | Value |
| Country | Dropdown | United States |
| How did you receive this credential? | Dropdown | Grandparented |
| State or Province | Dropdown | Alabama |
| Profession | Text | Test Doctor |
| Credential Type | Dropdown | Temporary |
| Credential Number | Text | 12345678 |
| Issue Date | Date | Today - 100 |
| Expiration Date | Date | Today - 0 |
| Error Message |
| Please add at least one. |
| Error Message |
| Error: Country is required. |
| Field Name | Data Type | Value |
| Country | Dropdown | United States |
| Error Message |
| Error: State or Province is required. |
| Error: City is required. |
| Error: School or Training Program Name is required. |
| Error: School Type is required. |
| Error: Date From is required. |
| Error: Date To is required. |
| Error: Type of Degree is required. |
| Error: Attendance Status is required. |
| Field Name | Data Type | Value |
| State or Province | Dropdown | Alabama |
| City | Text | test city |
| School or Training Program Name | Text | test School |
| School Type | Dropdown | College/University |
| Date From | Date | Today - 100 |
| Date To | Date | Today - 0 |
| Type of Degree | Text | Test Type of Degree |
| Attendance Status | Dropdown | Graduated |
| Field Name |
| Graduation Date |
| Field Name | Data Type | Value |
| Attendance Status | Dropdown | Attending |
| Field Name |
| Graduation Date |
| Link |
| Edit |
| Delete |
| Error Message |
| Error: Business Name is required. |
| Error: Type of Experience/Specialty is required. |
| Error: City is required. |
| Error: Country is required. |
| Field Name | Data Type | Value |
| Business Name | Text | Test Business Name |
| Type of Experience/Specialty | Text | test experiencee type |
| City | Text | test city |
| Country | Dropdown | United States |
| Error Message |
| Error: State or Province is required. |
| Error: Start Date is required. |
| Error: End Date is required. |
| Field Name | Data Type | Value |
| State or Province | Dropdown | Alabama |
| Start Date | Date | Today - 50 |
| End Date | Date | Today - 0 |
| Text |
| Indicates a required field |
| Error Message |
| Error: Have you been licensed in another state or jurisdiction where the standards are substantially equivalent to Washington State and would like to apply by reciprocity? is required. |
| Text |
| You need to provide a letter from your direct supervisor or other documentation directly from the residency program for each internship. |
| Text |
| Request your NCOPE or CAAHEP approved program send a certificate of completion or other documentation for each credential type you are applying for to the Department of Health. |
| Text |
| Indicates a required field |
| Error Message |
| Error: Have you successfully completed the prosthetist written multiple choice and patient simulation examination administered by the American Board for Certification in Orthotics and Prosthetics, Inc. (ABC)? is required. |
| Text |
| Indicates a required field |
| Error Message |
| Error: Required |
| Text |
| Based on your responses the following documentation is needed to support your applications review. If you do not have these listed documents currently you can submit the application and return to this page to upload the documents. Please note that once you upload a document you cannot delete it. A review must occur first before a replacement document can be uploaded. This may delay the processing time of your application. Please double check the document is correct before uploading. |
| Are you the spouse or registered domestic partner of military personnel? |
| Other License, Certifications or Registrations |
| Section Name |
| Official Transcripts |
| Jurisprudence Examination |
| Internship |
| Additional Information |
| Text |
| Have your official transcripts, which must indicate your degree and date granted, sent directly from your college or university to the Department of Health. |
| Request your NCOPE or CAAHEP approved program send a certificate of completion or other documentation for each credential type you are applying for to the Department of Health. |
| Error Message |
| Please check the checkbox. |
| Field Name | Data Type | Value |
| I agree. | Checkbox | true |
| Text |
| I understand the Department of Health may require more information before deciding on my application. The department may independently check conviction records with state or federal databases. |
| I authorize the release of any files or records the department requires to process this application. This includes information from all hospitals, educational or other organizations, my references, and past and present employers and business and professional associates. It also includes information from federal, state, local or foreign government agencies. |
| I understand I must inform the department of any past, current or future criminal charges or convictions. I will also inform the department of any physical or mental conditions that jeopardize my ability to provide quality health care. If requested, I will authorize my health providers to release to the department information on my health, including mental health and any substance abuse treatment. |
java.lang.AssertionError: expected [I, Automation Test, declare under penalty of perjury under the laws of the state of Washington the following is True and Correct: I am the person described and identified in this application. I have read RCW 18.130.170 and RCW 18.130.180 of the Uniform Disciplinary Act. I have answered all questions truthfully and completely. The documentation provided in support of my application is accurate to the best of my knowledge. I have read all laws and rules related to my profession. I understand the Department of Health may require more information before deciding on my application. The department may independently check conviction records with state or federal databases. I authorize the release of any files or records the department requires to process this application. This includes information from all hospitals, educational or other organizations, my references, and past and present employers and business and professional associates. It also includes information from federal, state, local or foreign government agencies. I understand I must inform the department of any past, current or future criminal charges or convictions. I will also inform the department of any physical or mental conditions that jeopardize my ability to provide quality health care. If requested, I will authorize my health providers to release to the department information on my health, including mental health and any substance abuse treatment.] but found [I, Jack peralta, declare under penalty of perjury under the laws of the state of Washington the following is True and Correct: I am the person described and identified in this application. I have read RCW 18.130.170 and RCW 18.130.180 of the Uniform Disciplinary Act. I have answered all questions truthfully and completely. The documentation provided in support of my application is accurate to the best of my knowledge. I have read all laws and rules related to my profession. I understand the Department of Health may require more information before deciding on my application. The department may independently check conviction records with state or federal databases. I authorize the release of any files or records the department requires to process this application. This includes information from all hospitals, educational or other organizations, my references, and past and present employers and business and professional associates. It also includes information from federal, state, local or foreign government agencies. I understand I must inform the department of any past, current or future criminal charges or convictions. I will also inform the department of any physical or mental conditions that jeopardize my ability to provide quality health care. If requested, I will authorize my health providers to release to the department information on my health, including mental health and any substance abuse treatment.] at org.testng.Assert.fail(Assert.java:94) at org.testng.Assert.failNotEquals(Assert.java:494) at org.testng.Assert.assertEquals(Assert.java:123) at org.testng.Assert.assertEquals(Assert.java:176) at org.testng.Assert.assertEquals(Assert.java:186) at page.actions.GenericActions.textOnAttestation(GenericActions.java:534) at stepDefinitions.Generic_StepDefinition.verifyTheTextOnAttestationPage(Generic_StepDefinition.java:201) at ✽.And Verify the text on Attestation page(featurefile/Sprint 9/RadiologicTechnologistCertification.feature:1100)
| Text |
| There is a $2.50 convenience fee required to use the online service when paying by credit card/debit card. The amount will be charged in addition to your fee(s). There is no additional convenience fee for ACH payments. |
| Fees submitted with applications for initial credentialing, examinations, renewal and other fees associated with the licensing and regulation of the profession are nonrefundable. |
| Link |
| WAC 246-12-340. |
| Timestamp | TestName | Status |
|---|---|---|
| Nov 2, 2022 08:52:29 PM | Validating the Intake Flow of Radiologic Technologist Certification.4.Validate that the HELMS portal Validations of Prosthetist License Intake flow | fail |
| Timestamp | TestName | Status |
|---|---|---|
| Nov 2, 2022 09:04:30 PM | Validating the Intake Flow of Radiologic Technologist Certification.4.Validate that the HELMS portal Validations of Prosthetist License Intake flow.And Verify the text on Attestation page | java.lang.AssertionError: expected [I, Automation Test, declare under penalty of perjury under the laws of the state of Washington the following is True and Correct: I am the person described and identified in this application. I have read RCW 18.130.170 and RCW 18.130.180 of the Uniform Disciplinary Act. I have answered all questions truthfully and completely. The documentation provided in support of my application is accurate to the best of my knowledge. I have read all laws and rules related to my profession. I understand the Department of Health may require more information before deciding on my application. The department may independently check conviction records with state or federal databases. I authorize the release of any files or records the department requires to process this application. This includes information from all hospitals, educational or other organizations, my references, and past and present employers and business and professional associates. It also includes information from federal, state, local or foreign government agencies. I understand I must inform the department of any past, current or future criminal charges or convictions. I will also inform the department of any physical or mental conditions that jeopardize my ability to provide quality health care. If requested, I will authorize my health providers to release to the department information on my health, including mental health and any substance abuse treatment.] but found [I, Jack peralta, declare under penalty of perjury under the laws of the state of Washington the following is True and Correct: I am the person described and identified in this application. I have read RCW 18.130.170 and RCW 18.130.180 of the Uniform Disciplinary Act. I have answered all questions truthfully and completely. The documentation provided in support of my application is accurate to the best of my knowledge. I have read all laws and rules related to my profession. I understand the Department of Health may require more information before deciding on my application. The department may independently check conviction records with state or federal databases. I authorize the release of any files or records the department requires to process this application. This includes information from all hospitals, educational or other organizations, my references, and past and present employers and business and professional associates. It also includes information from federal, state, local or foreign government agencies. I understand I must inform the department of any past, current or future criminal charges or convictions. I will also inform the department of any physical or mental conditions that jeopardize my ability to provide quality health care. If requested, I will authorize my health providers to release to the department information on my health, including mental health and any substance abuse treatment.] at org.testng.Assert.fail(Assert.java:94) at org.testng.Assert.failNotEquals(Assert.java:494) at org.testng.Assert.assertEquals(Assert.java:123) at org.testng.Assert.assertEquals(Assert.java:176) at org.testng.Assert.assertEquals(Assert.java:186) at page.actions.GenericActions.textOnAttestation(GenericActions.java:534) at stepDefinitions.Generic_StepDefinition.verifyTheTextOnAttestationPage(Generic_StepDefinition.java:201) at ✽.And Verify the text on Attestation page(featurefile/Sprint 9/RadiologicTechnologistCertification.feature:1100) |
| Name | Value |
|---|---|
| User Name | prince.gupta_mtxb2b |
| Time Zone | Asia/Calcutta |
| Machine | Windows 10 - 64 Bit |
| Selenium | 3.7.0 |
| Maven | 3.6.3 |
| Java Version | 1.8.0_151 |
| Name | Passed | Failed | Others | Passed % |
|---|---|---|---|---|
| @RadiologicTechnologistCertification1 | 0 | 1 | 0 | 0% |